DOJ launches probe into UnitedHealth’s Medicare billing practices: report

The Department of Justice has reportedly launched a civil fraud investigation into UnitedHealth Group’s Medicare billing practices as the company – and the insurance industry as a whole – face increased scrutiny.

The DOJ is looking into how UnitedHealth Group records diagnoses that set off extra payments to its Medicare Advantage plans, sources familiar with the matter told the Wall Street Journal.

Late last year, an analysis by the Journal showed that billions of Medicare records revealed significant increases in lucrative diagnoses for patients seen by UnitedHealth-employed doctors after enrolling in the company’s Medicare Advantage plans.

UnitedHealth said in a statement that the government regularly reviews all Medicare Advantage plans to ensure that they are compliant and that the company performs “at the industry’s highest levels on those reviews.”

“Any suggestion that our practices are fraudulent is outrageous and false,” UnitedHealth said.

Through Medicare, the federal government’s insurance program, people who are age 65 and older can sign up for Medicare Part A and Part B, which provide hospital and medical insurance. They can also opt for Medicare Part C, also known as a Medicare Advantage plan. It is a Medicare-approved plan from a private company that offers an alternative to Original Medicare and includes Part A, Part B and usually Part D, which helps cover the cost of prescription drugs.

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Justice Department attorneys have been interviewing medical providers cited in the Journal’s prior reports exposing how Medicare allegedly paid billions of dollars to UnitedHealth for questionable diagnoses. Those interviews took place as recently as January 31, according to the Journal. 

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But the investigation adds to a long list of woes for the company, which has faced an onslaught of public scrutiny over its denials of care even before UnitedHealth CEO Brian Thomposon was gunned down outside a New York City hotel in December in what police have called a “pre-meditated, targeted attack.”

Last fall, a Senate subcommittee accused UnitedHealthcare Group of denying claims to a growing number of patients as it tried to leverage artificial intelligence to automate the process. The report claimed that UnitedHealthcare’s prior authorization denial rate for post-acute care jumped from 10.9% in 2020 to 22.7% in 2022. United refuted these claims, saying the report “mischaracterizes the Medicare Advantage program and our clinical practices.” 

It came around the same time that the DOJ and attorneys general of Maryland, Illinois, New Jersey and New York filed a civil antitrust lawsuit to block UnitedHealth Group’s proposed $3.3 billion acquisition of rival home health and hospice services provider Amedisys Inc. over concerns that the deal would threaten care for vulnerable patients and harm home health and hospice nurses. 

The Department of Justice declined to comment.

FOX Business reached out to the Department of Health and Human Services’ Office of Inspector General, which is also involved in the investigation, for comment.